[Oxygen extraction as a predictor of mortality in patients on high frequency ventilation]. / Extracción de oxígeno como predictor de mortalidad en pacientes con ventilación de alta frecuencia.

INTRODUCTION: The high frequency oscillatory ventilation (HFOV) may reduce cardiac output. The haemodynamics were analysed and predictors of mortality identified. PATIENTS AND METHODS: A total of 48 children with respiratory failure undergoing HFOV between January 2003 and December 2010 were included. The study design was prospective, observational, and descriptive. Inclusion criteria were based on the existence of hypoxemia. The variables studied were: arterial and central venous pressure, arterial pH, venous saturation and oxygen extraction ratio, with determinations performed prior to HFOV, during, and before turning to conventional ventilation. Prognostic factors were identified by bivariate analysis and a predictive model of mortality was developed. RESULTS: The mean age was 21 [4 to 72] months. On admission, PRISM scales and Murray were 33 and 2.8, PaO(2)/FiO(2) of 61 and oxygenation index of 35. After HFOV an increase in pH (P<.001), mean arterial pressure (P<.001) and venous saturation, and decreased venous pressure and O(2) extraction (P<.001), was obtained. The prognostic factors of mortality at 24 hours after starting HFOV were: FiO(2), PaO(2)/FiO(2), oxygenation index, shunt, pH, central venous pressure and mean arterial pressure, venous saturation, and O(2) extraction. The model developed at 12 hours, consisting of EtO(2) and SvcO(2) was able to predict death with a probability of 92.3%. CONCLUSIONS: HFOV improves haemodynamics. The model at 12 hours is the best predictor of death.

[High-frequency oscillatory ventilation. A single-center study]. / Nuestra experiencia con la ventilación de alta frecuencia oscilatoria.

INTRODUCTION: High-frequency oscillatory ventilation is a safe and effective means of delivering mechanical ventilatory support. OBJECTIVE: To evaluate the safety and effectiveness of high-frequency oscillatory ventilation in pediatric patients with acute respiratory failure. PATIENTS AND METHOD: From August 2003 to July 2005, we performed a prospective observational study of 11 children older than 1 month who underwent high-frequency oscillatory ventilation. Pediatric risk of mortality scores (PRISM), Murray lung-injury scores and air leak scores were recorded at baseline before ventilation. The following variables were studied: ventilatory settings (FiO2 and mean airway pressure), gasometric (PaO2, SaO2, PaCO2, pHa, PaO2/FiO2 ratio) and hemodynamic parameters (Partm, PVC), and the oxygenation index. RESULTS: The overall survival rate was 82 %. Significant increases were found in PaO2 (p < 0.05), SaO2 (p < 0.05) and the PaO2/FiO2 ratio (p < 0.05), while mean airway pressure (p < 0.001), oxygenation index (p < 0.001), and FiO2 (p < 0.001) significantly decreased over time. CONCLUSIONS: High-frequency oscillatory ventilation significantly improved oxygenation in children with acute hypoxemic respiratory failure.

[Utility of procalcitonin, C-reactive protein and leukocyte count in the detection of meningococcal disease during an epidemic cluster]. / Utilidad de la procalcitonina, proteína C reactiva y recuento leucocitario en la detección de enfermedad meningocócica durante un brote epidémico.

OBJECTIVE: To determine the clinical utility of biological markers of the acute phase of bacterial infection (procalcitonin, C-reactive protein and leukocyte count) in invasive meningococcal disease during an epidemic cluster. PATIENTS AND METHODS: Thirty-six patients with feverish syndrome who visited the emergency unit of our hospital within a 6-month period were studied. In all patients, serum procalcitonin and C reactive protein levels and leukocyte count were determined, and blood culture was performed. RESULTS: Invasive meningococcal disease, confirmed by blood culture, was found in seven of the 36 patients studied. The most frequent clinical presentation was a feverish syndrome of less than 24 hours of onset, progressing to sepsis in subsequent hours. Comparison of procalcitonin and C reactive protein concentrations in patients with and without meningococcal disease revealed that procalcitonin and C reactive protein levels greater than 10 ng/ml and 49.95 ng/ml respectively had high sensitivity, specificity and predictive values. Procalcitonin levels < 0.5 ng/ml were useful to easily rule out invasive meningococcal disease. In the case of leukocyte count, no value with clinical significance could be established, although counts were higher in patients with invasive meningococcal disease. CONCLUSIONS: The finding of prolactin levels of < 0.5 ng/ml and/or C-reactive protein levels of < 49.95 ng/ml in children or teenagers with fever of less than 24 hours of onset indicates a low probability of invasive meningococcal disease in epidemic situations.

[Renal failure as a factor leading to epileptic seizures]. / Insuficiencia renal como factor desencadenante de crisis epilépticas.

OBJECTIVE: To analyze the incidence of convulsive seizures in renal failure by studying the semiological characteristics of the convulsive episodes, their subsequent evolution and the presence of possible sequelae. The relationship between the different potential causes of the seizures and their evolution and treatment was also analyzed. MATERIAL AND METHODS: We retrospectively reviewed the clinical histories of 108 patients admitted to the hospital over a 20-year period with a diagnosis of renal failure: 55 were undergoing predialysis, 42 renal transplantation, 7 peritoneal dialysis and 3 hemodialysis. One patient was excluded for not fulfilling the selection criteria. Computer study of the 18 quantitative and qualitative variables was carried out with the SPSS 9.0.1 program. RESULTS: Of the 107 patients, 16 (14.95 %) had suffered some type of convulsive seizure. None was in the predialysis group. As triggering factors, hydroelectrolyte imbalance was found in eight patients and hypertension was found in four. In the remaining patients the causes were not well-defined. Only three patients with epilepsy prior to renal failure presented sequelae. CONCLUSIONS: Epileptic seizures in renal failure in childhood can be considered as occasional seizures that do not usually become chronic or produce sequelae. Information on the management of seizures in renal failure should be disseminated among professionals treating systemic diseases.